Alexander Jeffrey A, Weiner Bryan J, Shortell Stephen M, Baker Laurence C
School of Public Health, University of Michigan, USA.
Hosp Top. 2007 Spring;85(2):3-12. doi: 10.3200/HTPS.85.2.3-12.
The authors examined how the association between quality improvement (QI) implementation in hospitals and hospital clinical quality is moderated by hospital organizational and environmental context. The authors used Ordinary Least Squares regression analysis of 1,784 community hospitals to model seven quality indicators as a function of four measures of QI implementation and a variety of control variables. They found that forces that are external and internal to the hospital condition the impact of particular QI activities on quality indicators: specifically data use, statistical tool use, and organizational emphasis on Continuous Quality Improvement (CQI). Results supported the proposition that QI implementation is unlikely to improve quality of care in hospital settings without a commensurate fit with the financial, strategic, and market imperatives faced by the hospital.
作者研究了医院质量改进（QI）实施与医院临床质量之间的关联如何受到医院组织和环境背景的调节。作者对1784家社区医院进行普通最小二乘法回归分析，将七个质量指标建模为QI实施的四项措施以及各种控制变量的函数。他们发现，医院内部和外部的力量调节了特定QI活动对质量指标的影响：具体而言，数据使用、统计工具使用以及组织对持续质量改进（CQI）的重视。结果支持了这样的观点，即如果与医院面临的财务、战略和市场需求不相适应，QI实施不太可能提高医院环境中的医疗质量。
